Author Information

Ruth L. Collins-Nakai, MD, FACC, FRCP[C], Chairman,

Hans A. Huysmans, MD, PhD and

Hugh E. Scully, MD, FACC, FACS, FRCS(C)

Abstract

It is apparent that in most countries outside the United States, cardiovascular services are limited to some extent by government, often with the participation and advice of physicians and the public. In many countries, fee-for-service amounts are negotiated between physician associations and paying agencies, whether they are government or sickness funds. In virtually all countries studied, emergencies and urgent cases are determined on a medical basis. Additional centers for either cardiac surgery or catheterization have, in Germany, the Netherlands, Sweden, United Kingdom, Canada and Australia, been added on the basis of perceived need (physician and public input). In all countries studied, other than the United States, provision is made to provide cardiovascular services to persons unable to afford them.

Physicians in all systems remain free to make clinicaldecisions modified by “available resources.” As constraints are imposed on resource allocation within the health care systems, the methods used in decision-making and by regulatory authorities are being reviewed in all countries studied. Initiatives to develop better methods to improve clinical decision-making through the establishment of practice guidelines, clinical audits and quality assurance methods are widespread in the systems compared.

In the United States, regulation of the minimum numbers of procedures required for competence and the minimum case load per catheterization laboratory or surgical unit may well free up sufficient resources to cover those parts of the American population not currently receiving cardiovascular services.

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